| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $94.13 | $689.21 | $689.21 | |
Cigna
| Facility | $111.95 | $188.12 | $188.12 | |
Cigna
| Professional | $111.95 | $152.97 | $188.12 | |
Providence
| Facility | $99.88 | $179.16 | $188.12 | |
Providence
| Professional | $111.95 | $141.19 | $193.69 | |
United
| Professional | $80.78 | $89.38 | $102.32 |